The invention relates to a medical device for physical therapists, particularly for performing upper and lower extremity exercises for the physical rehabilitation of bed-bound patients. More particularly, the invention relates to a generally wedge shaped compressible article for allowing patients to perform exercises while lying down, most likely confined to their hospital bed, which will aid them in increasing upper and lower extremity strength which is essential for returning to standing and walking activities. The medical device is preferably disposable, in that the article should not be shared between patients.
In the acute and sub-acute rehabilitation setting, the patients may be very ill and often are confined to a hospital bed. This proves to be a very challenging situation from a therapeutic standpoint and limits a physical therapist to basic bedside exercises. In addition, physical therapists are limited by the amount of time due to the number of patients they see and resources that are available. Lack of time and resources coupled with the poor health of the patients in these settings can leave the patients at great risk for developing secondary complications such as pneumonia, muscle atrophy, decubiti, and osteoporosis due to inactivity or severely decreased activity. This type of situation normally requires that the patient recover from a very tenuous medical state before initiating aggressive physical therapy and typically requires a relatively lengthy period of hospitalization.
Initiating early physical therapy that can be performed in bed by the patient can permit the patient to begin strengthening all of the major upper and lower extremity muscle groups such as shoulder flexors, adductors and abductors; elbow extensors; hip and knee flexors and extensors; hip adductors and abductors; and ankle plantar flexors.
An early rehabilitation regimen can help to speed up the patient""s recovery process and allow the patient to progress towards a more advanced exercise regimen when the patient""s health is improved to the point where they no longer need to be confined to a bed.
At the present time, a patient in an acute or sub-acute setting may not often be afforded an opportunity to participate in one or more therapeutic exercise sessions on a regular daily basis due to lack of resources or a high patient to therapist ratio.
Physical therapists often work with critically ill patients in intensive care wards as well as the neurosugery and orthopedic wards. Many of these patients are severely ill, having sustained strokes, organ transplants, spinal cord injuries, head injuries, joint replacements and the like. Many of these patients cannot get out of bed for weeks, and in some instances for 2-3 months, without the maximal assistance of two-four healthcare providers. The job of the physical therapist is to find a way to help these patients exercise. In some cases, the patient""s exercise consists of the physical therapist moving each limb and joint through a specific range of motion for the patient. Some patients show little or no progress even after weeks of this activity. Moreover, it is physically exhausting work for the patient and for the therapist. In other cases, some patients progress from the point where the therapist moves their limbs to the point where they can perform some resistance exercises to begin strengthening their muscles. However, for the therapist, this can be even more exhausting because the patients require an added resistance, which must be supplied by the therapist, in order to begin to increase muscle mass.
Exercising the upper extremities can be easier for the therapist because surgical tubing, or Theraband(trademark), can be tied to the bed at different angles and patients can exercise most upper body muscles with supervision and minimal assistance from the therapist. However, the lower extremities are another issue. There is no easy way to assist bed-bound patients in strengthening their legs. The only way to assist these patients is by the therapist providing manual resistance. This allows the patient to perform lower body exercises but is inefficient, time consuming, exhausting for the therapist who must serve as the provider of the resistance. Typically, the standard of care is for the therapist to visit these inpatients twice a day. However, because of the large number of patients and the relatively small number of therapists, it can be impossible to provide quality therapeutic time to the sickest of patients, who unfortunately, are the patients that need and would benefit from these sessions the most.
In many instances, patients that require resistance exercises are still critically ill and cannot be moved from bed, except to sit in a chair by their bedside for 10-15 minutes two or three times a day. They still require maximal assistance from healthcare providers to move from their beds to chairs. However, movement and exercise is crucial for these patients. It has been documented that muscle tissue can begin to atrophy in even the healthiest of test subjects after just three days of bed rest. As a result, many such critically ill patients are very unhealthy regarding the deterioration of muscle tissue since they have been confided to bed for weeks or months. Additionally, static positioning for these patients can increase the risk of secondary complications such as infection, blood clots, bed sores, and pneumonia. This is why it is important to apply a means to allow very ill patients to exercise one or more times a day without the need for the direct personal or physical involvement of a therapist at each session.
Some common ways that therapists can provide a source for resistance are not very efficient and are not always popular with the other healthcare providers. Therapists sometimes use extra bed sheets, towels, and blankets to serve as a make-shift lower body gym. Placed under the knees, the patient could extend their knees to strengthen the anterior thigh muscles. Moving the linen around and positioning it properly with regard to the patient can also allow the patient to exercise some different muscle groups, but it often does not allow for quality sessions. For example, the sheets often do not hold up to the weight of the legs and would lose shape very quickly. Also, the nursing and logistics staffs may not appreciate the therapist using extra linen for such purposes because it would require a great deal of extra linen to support the therapeutic exercise efforts of all the patients in a rehabilitation hospital on a daily basis. However, the main deterrent is not the nursing or logistics staffs, but rather the lack of success with using linen material, which is not designed for such a purpose, and its limited availability.
Regarding upper and lower body exercises, some standard exercises are described hereinafter as examples and are not intended to be all inclusive. In regard to the upper body, an elbow extensor strengthening exercise requires the patient to apply pressure against a resistance with bent elbows in an effort to straighten the elbows.
Two common shoulder strengthening exercises are shoulder abductor and adductor exercises. Performing the shoulder abductor exercise requires the application of force or lifting the arm or shoulder away from the body in the frontal plane against a resistance. The shoulder adduction exercise is performed the same as the shoulder abductor, except it requires the application of force or moving the arm across the body. These upper body exercises most often require the therapist to serve as the resistance for the patient to push or move against.
A lower body exercise commonly used to strengthen a patient""s hip and knee flexors and extensors involves having the patient bend his knees slightly and then to have some resistance applied to the bottom of his feet. The patient will then attempt to straighten his legs. As indicated above, the physical therapist can simply use her hands to push against the patient""s feet in order to provide the resistance, or she may use pillows, sheets, blankets and other articles which can be found on the hospital ward to put between the patient""s feet and the footboard for the patient to push against. However, these items, even when the they can be found in sufficient quantities, are not well suited for the task. Furthermore, these items are not designed to be subjected to repeated compression and relaxation and can quickly lose their resiliency, making them ineffective to the point where the therapist has to provide resistance manually.
A common exercise to strengthen a patient""s knee extensors requires that the patient lie supine with knees bent and resting on a pillow, roll of blankets, or sheets. To perform the exercise the patient will extend his legs upwards, lift his heels off the bed, and then return his legs back to a bent position with his heels returned to the bed. This will be repeated for a certain number of repetitions.
An exercise for strengthening hip adductors requires an article, whether a pillow or a roll of blankets, to be placed between a patient""s thighs wherein the patient performs the exercise by squeezing the article between his thighs and then releasing. This is repeated for a certain number of repetitions. The physical therapist may add resistance to the exercise manually, if desired, by using her hands.
A common exercise to strengthen a patient""s hip abductors requires that the patient force his leg, typically one leg at a time, in an outward direction against a resistance. Generally, the therapist may push on an outside portion of the patient""s knee or may place a pillow or roll of blankets between the patient""s knee and a hospital bed rail.
To strengthen a patient""s plantar flexors the therapist may push on the patient""s forefoot, or in the alternative, place a bundle of blankets or pillows between the patient""s feet and the footboard and have the patient attempt to point his toes towards the end of the bed by moving his foot at the ankle.
In each of the described exercises, the level of resistance can play a very important role in the strengthening of the particular muscle group. The patient performs each exercise while laying in bed in a supine position. The physical therapist may frequently have to provide resistance manually because items like pillows and rolled up blankets or sheets can quickly lose their ability to provide even a minimal amount of resistance during the repeated cycles of compression and relaxation required by the therapeutic exercises. The use of manual resistance, besides being physically tiring, also requires the therapist to spend a larger amount of time with each patient. As a result, a patient is always not afforded an opportunity to participate in frequent therapeutic exercise sessions on a regular daily basis which is critical if strength gains are to be achieved by the patient in this medical setting.
Therefore, there is a need for a suitably designed medical device which can, under the guidance of physical therapist, permit a patient to perform a number of therapeutic exercises on a regular basis many times a day while the patient is confined to bed. The patient would be able to privately perform the therapeutic exercises without requiring the personal attention of a physical therapist at every session. Regular and consistent performance of these exercises, made possible by such a medical device, can provide muscle strengthening and early weight bearing type exercises which could possibly enable a patient to more quickly regain the ability to stand and walk. Furthermore, such a medical device could standardize the manner in which exercises are performed in the medical setting. The therapist would no longer have to rely on extra pillows and blankets in the hospital ward and the therapist would also not be required to exert manual resistance with each patient. Such a device can help the therapist to treat more patients on a daily basis more effectively.
U.S. Pat. No. 3,009,172 to Eidam, U.S. Pat. No. 3,555,582 to Radford, U.S. Pat. No. 4,502,170 to Morrow, U.S. Pat. No. 5,479,667 to Nelson et al., U.S. Pat. No. 3,648,308 to Greenwalt, and U.S. Pat. No. 4,913,150 to Vineberg all disclose and describe generally wedge shaped articles for supporting the head and other portions of the upper body of an individual. Eidam describes a xe2x80x9chead suspending pillowxe2x80x9d having a xe2x80x9cpillow body 4xe2x80x9d with a xe2x80x9cshoulder supporting portion 6 which might be generally determined from its lower end portion 8 to a portion transversely of the line 10, which line is a vertical line on the side of the pillow between the head and shoulder portions.xe2x80x9d The xe2x80x9chead portion 14xe2x80x9d can be provided with a xe2x80x9crecess 16xe2x80x9d which is U-shaped and can extend from the top to the bottom of the pillow. Eidam also states that xe2x80x9cthe lower portion of the taper or the shoulder-supporting portion 6 may be brought to a sharper edge at 8 if desired, but the principal object of the pillow is to provide a shoulder supporting portion 6 which will relieve a great deal of the body weight in a head supporting portion 14 with its recess 16, the latter providing for minimum contact between the head supporting portion and the head of the sleeper.
Similarly, Radford also discloses a wedge shaped article described as a xe2x80x9ctherapeutic devicexe2x80x9d having generally flat support surfaces 6 and 8, respectively in upper surface 20 which intersects the bottom 6 and back 8 surfaces, to form upper and front edges 14 and 16, respectively. The therapeutic device is also described as having a xe2x80x9csinuously curved upper surface 20xe2x80x9d which has xe2x80x9ca plurality of alternatively disposed convex 15 and 17 and concave 19, 21 portions which merge smoothly with one another to form a continuous surface and which are angularly disposed with respect to one another being adapted to position certain portions of the users head, neck and back in predetermined relation with respect to one another when the support is resting either on the bottom surface 6 or the back surface 8. Moreover, Radford states that xe2x80x9cwhen the device 2 is resting on the bottom surface 6, the concave portions 19 and 21 are adapted to receive the posterior occupit and posterior mid-dorsum of the user whereas, when the device is resting on the back surface 8, the concave portions 19 and 21 are adapted to receive and properly posterior mid-sacrum and posterior mid-dorsum respectively.xe2x80x9d
Morrow describes a xe2x80x9cphysiologic support system and methodxe2x80x9d and describes a xe2x80x9cmethod for improving posture and relieving lower back pain including the steps of pressure a convex pillow against the region of the ilia, sacrum and fifth lumbar vertebrae to produce a substantially sacral base angle and fully oppose any movement tending to cause rotational shifting of the pelvis, and supporting the thighs and calves in an elevated position such that the thigh extend upwardly at an angle of from about 53xc2x0 to 63xc2x0 from horizontal and the calves extend of an angle of from about 0xc2x0 to 20xc2x0 downwardly from horizontal.xe2x80x9d Morrow discloses that the xe2x80x9ccalve support 12bxe2x80x9d is angled with respect toxe2x80x9cthigh supporting surface 12axe2x80x9d such that the leg muscles xe2x80x9cexert forces on the pelvis P which are consistent with and supportive of the forces which are being exerted by pelvic support pillow 10.xe2x80x9d
Nelson et al. discloses a xe2x80x9cergonomic pillow assemblyxe2x80x9d which is described as having xe2x80x9ca head support assembly 36xe2x80x9d with a xe2x80x9cthoracic support section 38xe2x80x9d and a xe2x80x9clumbar support assembly 39.xe2x80x9d Similarly to Eidam and Radford, Nelson et al. discloses a wedge shaped device which tapers to a relatively thin front edge, which is consistent with its intended use of supporting comfortably the head, neck and upper torso of a person who is lying on the pillow.
Greenawalt and Vineberg both disclose wedge shaped compressible articles for supporting the head, neck and thorax of a person. Greenawalt additionally discloses a raised member on the sloping surface which can act as a cervical spine support. Two United States Design Patents, Pat. Nos. Des. 334,134 to Kalatsky and Des. 360,796 to Golado, also disclose generally wedge shaped articles made of a compressible material.
In regard to all of the devices showing generally wedge shaped pillows or therapeutic devices, particularly Eidam, Radford, Morrow and Nelson et al., each of those articles tapers to a relatively narrow front edge, in contrast to the xe2x80x9cgenerallyxe2x80x9d wedge-shaped medical device according to the invention. However, that feature is consistent with the intended purpose of each of those articles, which is to generally support the head and upper torso portions of a person who lies down on top of the medical device with their head, neck and perhaps portions of their upper torso, positioned on top of the article. If there were more than a narrow front edge provided on each of those articles, the article would be uncomfortable to lie on, thus defeating the intended purpose of the article. Unlike these devices, the generally wedge-shaped device which will be described in more detail hereinafter, is designed not to support the neck or upper body of a person who lies on the medical device, but rather to be used as a resiliently compressible article for performing therapeutic upper and lower body exercises. Generally, these therapeutic upper and lower body exercises involve a patient using their arms, legs and feet to compress the resilient article against a rigid surface, such as the foot board or side rails of a bed or against a wall.
U.S. Pat. No. 3,648,308 to Greenawalt and U.S. Pat. No. 4,193,150 to Vineberg both disclose wedge shaped compressible articles for supporting the head, neck and thorax of a person. Additionally, Greenawalt discloses a raised member on the sloping surface which can act as a cervical spine support. United States Design Pat. No. Des. 336,134 to Kalatsky and Des. 360,796 to Goldado, also disclose wedge shaped articles made of a compressible material. Kalatsky shows a wedge shaped ornamental design for an orthopedic back cushion. Goldado discloses a wedge shaped ornamental design having a detachable foot rest portion. Kalatsky and Goldado do not provide either a rear support base or a front support base and also are not designed to be repeatedly compressed and relaxed to perform therapeutic exercises.
Therefore, in view of the lack of any articles designed to meet the needs of physical therapists for treating patients who are confined to a bed, it would be very desirable to provide a compressible wedge shaped medical device, and method for using such, which has front and rear support surfaces and side support surfaces. Such a medical device can be used by patients confined to a bed for performing exercises which can strengthen all major upper and lower extremity muscle groups. In this manner, an early aggressive physical therapy regimen can be initiated which can decrease recovery time by increasing upper and lower extremity strength which is essential for an earlier return to out of bed activities such as standing and walking.
A wedge shaped medical device is provided which can be used by physical therapist to treat patients who are confined to a bed. Such a medical device having features of the present invention can include a generally wedge shaped article constructed of a compressible material having an expansive front support base, an expansive rear support base taller than the front support base, a generally flat bottom surface, left and right side surfaces, and a top surface which slopes upward from the front support base to the rear support base. The front and rear support bases, and particularly the front because that is the surface which the patient must push against with his feet, can preferably have a length and width forming a surface expansive enough to provide stable surfaces for compressing the medical device against a flat surface, such as the footboard of a bed or a wall. Additionally, the dimensions of the medical device can be chosen such that the sloping upper surface can have an angle designed to provide a proper range of movement for a therapeutic exercise. Further alternative features of the medical device can include a pair of opposed indentations in the sides surfaces of the device. The indentations can be positioned at a location along the sides of the device chosen to provide an anatomically comfortable fit for the patient""s thigh and knee joints.
The medical device can be designed to permit the patient to perform exercises which can strengthen all of the major upper and lower extremity muscle groups while he is lying in a hospital bed in a supine position. Almost without exception, hospital beds have side rails and a footboard, each of which can be used as a barrier to abut the support surfaces of the medical device. However, if for some reason the hospital bed did not have side rails, or a footboard, or if the patient were confined to a bed in the patients home which did not have side rails or a footboard, the patient could be assisted in lying in a supine position on the floor, preferably on a mat, next to a wall with the medical device abutting the wall to perform the exercises.
The medical device can preferably be formed of a disposable, hypoallergenic, and flame retardant resilient material, such as foam, for health and safety reasons. Each patient could receive one such medical device for his or her personal use only. The medical device can result in benefits for the patient, the medical staff and the hospital in general. The medical device can provide a patient who is confined to a bed with a means for performing many therapeutic muscle strengthening and early weight bearing type exercises which are key components of transfer training or teaching patients to move from one position to another position. For example, the medical device can be used to perform a type of exercise commonly known as a leg press which is a component of sit-to-stand transfers. Another exercise the medical device can be used to perform is known as hip adduction and is important for rolling in bed and supine-to-sidelying-to-sit transfers.
Allowing a patient to participate in many exercise sessions each day on a regular daily basis can provide the intensity that is needed to promote this necessary strengthening and may assist in decreasing hospitalization time. Shorter hospitalization can lead to decreased charges to the patient and his or her insurance company. The use of such a medical device can also standardize how these exercises are performed in the medical setting. Currently, physical therapists most often use whatever can be found in the hospital ward to assist them with the exercises. The therapists often have to rely on pillows, blankets, and other items that are not always available. Often they must provide manual resistance with their own hands because of the unsuitability of such items for use in exercises requiring repeated compression and relaxation of the item. Using manual resistance is also both tiring and time consuming. Use of equipment like the present medical device can allow a therapist to work with many more patients because standardized exercises can be performed by the patient either without any supervision at all, or under supervision that could be provided by any medical staff member. Additionally, if patients are able to recover more quickly with assistance of such a medical device, hospitalization time can be shortened and the cost of providing medical care can be reduced.